Wellness

ACA Compliance

Posted July 23, 2014

Compliance with the Affordable Care Act (ACA) is a concern that weighs heavy on the minds of many employers. The ACA regulations for health care benefits are causing insurers and employers to take a closer look at their benefit plans. No one wants to be out of compliance. The good news is that most regulations don’t apply to stand-alone dental plans.

Under the ACA, medical insurers must offer a specific set of essential health benefits to individuals and small employers, including dental and vision benefits for those under age 19. However, those benefits don’t affect the stand-alone dental plans employers already have in place.

2015 mandateBeginning in 2015, employers with 100 or more employees will be subject to the employer mandate. Employers in this group will need to offer minimum coverage (in other words, typical employer-sponsored medical coverage) to 70 percent of their full-time employees. Because minimum essential coverage does not include dental or vision, employers can keep the dental and vision plans they already have.

Employers with 50 to 99 employees will not be subject to any employer mandates, including offering minimum coverage or essential health benefits, until 2016.

Purchasing coverageEmployers are not required to purchase health coverage for employees and their dependents through a health insuranceexchange. Typically, they can keep their medical, dental and vision benefits with their current insurance carriers. Medical plans may change and could include pediatric dental benefits that medical carriers are required to offer by the ACA. Even so, the family dental plan in place can stay as is, providing added value without medical plan parameters. If the medical plan changes, but does not include the specified pediatric dental benefits, the family dental plan can be modified to include them.

Family dental and vision needsWhen it comes to dental and vision health, the ACA has focused on the needs of younger family members, leaving adults to purchase any dental and vision plans separately for themselves and their dependents age 19 and older.

In most families, members have different needs for dental and vision care, requiring coverage that can be customized to their specific needs. Benefit surveys show that people with dental and vision coverage are likely to schedule regular checkups and exams so doctors can evaluate the health of their teeth and eyes, and develop a treatment plan to address concerns.